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Pneumococcal (Streptococcus pneumoniae) polysaccharide vaccines in children

Elaine I Tuomanen, MD
Section Editor
Sheldon L Kaplan, MD
Deputy Editor
Mary M Torchia, MD


Streptococcus pneumoniae (pneumococcus) is a leading cause of serious illness among children worldwide [1]. Before universal infant immunization with pneumococcal conjugate vaccine (PCV) in the United States, S. pneumoniae caused approximately 17,000 cases of invasive disease each year among children younger than five years of age, including 700 cases of meningitis and 200 deaths [2]. It was the most frequent cause of bacteremia, pneumonia, meningitis, sinusitis, and acute otitis media.

The development of the pneumococcal vaccine, the first vaccine derived from a capsular polysaccharide, was an important landmark in medical history. The polysaccharide antigens were used to induce type-specific antibodies that enhanced opsonization, phagocytosis, and killing of pneumococci by phagocytic cells. The tetravalent vaccine was first used in 1945. However, it was not widely distributed because its deployment coincided with the discovery of penicillin [3]. Vaccination programs were largely abandoned because pneumococcal disease was so easily controlled by antibiotics. The development and increasing prevalence of multiple-antibiotic-resistant strains has once again made prevention of pneumococcal disease a priority. (See "Resistance of Streptococcus pneumoniae to beta-lactam antibiotics".)

The use of pneumococcal polysaccharide vaccines in children will be reviewed here. The use of conjugate pneumococcal vaccines in children and pneumococcal vaccination of adults are discussed separately. (See "Pneumococcal (Streptococcus pneumoniae) conjugate vaccines in children" and "Pneumococcal vaccination in adults".)


The surface capsular polysaccharide of S. pneumoniae provokes a type-specific protective immune response and serves as the basis for serotyping of these organisms. At least 99 different pneumococcal serotypes have been identified. Serotypes 6, 14, 18, 19, and 23 are the most prevalent, accounting for between 60 and 80 percent of infections depending upon the area of the world. (See "Microbiology and pathogenesis of Streptococcus pneumoniae", section on 'Capsule'.)

It is not possible to include all of the serotypes in a polysaccharide vaccine. Vaccines representing subgroups of the most prevalent serotypes causing invasive disease have been formulated. A 14-valent polysaccharide vaccine (PPSV14) was developed in the 1970s [4]. The 23-valent polysaccharide vaccine (PPSV23) was developed in 1983. Polysaccharide vaccines generally are not considered to be immunogenic in children younger than two years [5,6], the age group with the highest incidence of invasive disease. The development of protein-polysaccharide conjugate vaccines was necessary to improve prevention of pneumococcal disease in these young children. Pneumococcal conjugate vaccines are discussed separately. (See "Pneumococcal (Streptococcus pneumoniae) conjugate vaccines in children".)

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Literature review current through: Nov 2017. | This topic last updated: Jun 07, 2017.
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